Marine Hospital, the Ellis Island Marine Hospital, and a marine hospital at Sheepshead Bay; Mobile, Ala.; Savannah, Ga.; and New Orleans. Mr. LUDLOW. You can put a list of those in the record. Mr. LUDLOW. Will you turn to page 22 of the justifications and take a look at the items for other obligations? TRAVEL In the specific estimates you have an item for travel of $14,115, in addition to the original appropriation of $47,900. What is the explanation of this substantial increase in the travel item? Dr. ANDERSON. The fiscal year 1946 appropriation in the amount of $47,900 is for the travel of patients and escorts and there is a deficiency of $14,115. This travel involves a movement of leprous persons to Carville, La., the transfer of tuberculous, mental and cancer patients to facilities specially equipped for specialized treatment of such patients, and on occasion the transfer of patients from a congested station to one better able to accommodate them. That involves an average cost of travel of $9.78 per patient per year for travel. We get that figure by taking the amount for the fiscal year 1945, which was $64,110, which was obligated for travel, and divide that by the daily average patient load in 1945 of 6,555.2 and that gives you the result of $9.78. Mr. LUDLOW. Why should the travel go up? Dr. ANDERSON. The travel item has increased because of the increased daily average load. The daily average load estimated for the fiscal year 1946 is 6,342 patients. Therefore, multiplying that amount by $9.78 per patient year, will give you the total requirement of $62,015. EXPENDITURES FOR FIRST HALF OF FISCAL YEAR Mr. LUDLOW. How much did you spend for travel in the first 7 months? Dr. ANDERSON. I can give you the figure for the first 6 months. Mr. LUDLOW. Suppose you give us that. Dr. ANDERSON. For travel in the first 6 months we have expended $25,086. Mr. LUDLOW. That is half of your total appropriation if this deficiency is granted. Dr. ANDERSON. That is right, sir; but in giving you this figure it must be recognized that there is a backlog in the processing of travel vouchers. We do know that is not the full amount which we will have to pay. TRANSPORTATION OF THINGS Mr. LUDLOW. All of these items go up very appreciably. For instance, for transportation of things there is an increase of $57,992, from $88,017 to $145,939. That is an increase of $57,922. What is the explanation there? Dr. ANDERSON. The explanation is largely concerned with the additional supplies and materials which are needed to make up the backlog accumulated during the year. The original 1946 appropriation for transportation of things was $88,017. The deficiency is $57,922, and that is due in part to the inadequate amount provided in the original allowance, and to the fact that with the termination of hostilities and the availability of surplus property it is intended to take advantage of these stocks in order to begin replacement of worn-out equipment in marine hospitals. COMMUNICATION SERVICES Mr. LUDLOW. For communication services the amount requested is $20,228 over the base of $52,408 in the 1946 appropriation. Dr. ANDERSON. For the fiscal year 1946 there was an appropriation of $52,408 for communication services, and there is a deficiecny of $20,228. This deficiency was computed by projecting the monthly rate of obligations of $6,053 for the first 5 months of the year over a 12-month period, which shows a requirement of $72,636. EXPENDITURES, FIRST HALF OF FISCAL YEAR Mr. LUDLOW. What is the expenditure for the first 6 months? Dr. ANDERSON. For communications services the expenditure for the first 6 months was $35,244. Mr. LUDLOW. That is not quite half of your total estimate. Dr. ANDERSON. That is correct. If I could give you that figure as of today, it would show somewhat of an increase. Mr. LUDLOW. What sort of communications was that for? Dr. ANDERSON. That is primarily for telephone and telegraph service and the installation of PBX services. LONG-DISTANCE TELEPHONE CALLS Mr. LUDLOW. What proportion of the telephone service is for long-distance telephone calls? Dr. ANDERSON. I do not believe I can furnish that at this time? Mr. LUDLOW. Do you have regulations that limit to appropriate dimensions the use of long-distance telephones? 83715-46- -4 Dr. ANDERSON. We have general instructions. Mr. LUDLOW. You try to limit that? Mr. ANDERSON. That is right. We are now engaged in a study of communications services expenditures. RENTS AND UTILITY SERVICES Mr. LUDLOW. What is the explanation of this increase of $47,998 for rents and utility services? Is that space rent, or machine rent, or both? Dr. ANDERSON. The expenditures for the first 5 months of the fiscal year 1946 indicate that about $32,841 per month is required for utility services. That projected over 12 months indicates that $394,099 will be required in 1946. Mr. LUDLOW. You spoke of utility services; the table covers both rents and utility services. Dr. ANDERSON. The only item for rents is $10,250 for the payment of rent to the State of New York for the use of the Neponsit Beach Hospital. That is one-third of the annual rent we have to pay. OTHER CONTRACTUAL SERVICES Mr. LUDLOW. The largest increase is for other contractual services, where there is an increase shown of $883,258 over a base of $842,905 in the original 1946 appropriation. In other words, you more than double this appropriation if this increase is granted. What is the situation? Dr. ANDERSON. The situation is that in the fiscal year 1946 the appropriation was $799,320 less than the actual expenditures in 1945, and the requirements in 1946 exceed the actual expenditures of 1945 by $83,938. That latter figure, in our opinion, represents more truly the increase in the item. Mr. LUDLOW. Why should there be a greater number of patients in 1946 than in 1945? Dr. ANDERSON. The fact is, there are only slightly more. an inadequate appropriation to begin with. SUPPLIES AND MATERIALS It was Mr. LUDLOW. For supplies and materials you are asking for quite an increase, in the amount of $511,156. What is the situation there? Dr. ANDERSON. In the item for supplies and materials there is a deficiency of $511,156. Of this amount, $395,921 is for subsistence and arises from the difference between the fiscal year 1946 allowance of 55 cents per ration and the experience to date in 1946 of 67.3 cents. The request allows for an estimated 3-percent reduction in the patient load for the fiscal year 1946, which is estimated to be 6,342 as compared with 6,555 for the fiscal year 1946. EQUIPMENT Mr. LUDLOW. Why should the equipment item go up from $287,185 to $539,979, or nearly double your original appropriation? What is in that picture? Dr. ANDERSON. The main reason for this increase is connected with the fact that during the war years the expenditure for equipment has been below the level of normal replacement needs. That compared with the total requirements for 1946 of $827,164 represents an increase of $539,979 over the allowance of $287,185 in the original appropriation. We are experiencing extreme difficulty in operating our hospitals with the equipment on hand. During the war the expenditure for major equipment was very much reduced. For example, at our hospital in Evansville, Ind., our present X-ray does not function effectively. That interferes with professional work, and because the X-ray pictures are not satisfactory, we have to repeat the process. At our hospital in Louisville, Ky., the chief nurse calls my attention to the very serious situation on the wards in connection with some basic items of equipment. TYPES OF EQUIPMENT COVERED Mr. LUDLOW. What types of equipment does this item cover? Dr. ANDERSON. Most of the request is directed to replacement, which will include such things as X-ray machines, dental chairs, food carts, and equipment in the dietetic department, and also many other items in connection with the various treatment and examining rooms. Mr. LUDLOW. Can you get this equipment? Dr. ANDERSON. Through the utilization of materials that are declared surplus by the several governmental agencies, and also there are in the open market new items that cannot be secured from surplus, but which are beginning to come on the market. Mr. LUDLOW. Are any automobiles included in this? Dr. ANDERSON. In this request; no, sir. Mr. LUDLOW. How much equipment are you getting from the Army and Navy surplus? Dr. ANDERSON. I requested a statement from our Property Section, the Chief of which advised me that in the neighborhood of $200,000 had been expended for surplus property, and I would judge that because of the large operating nature of the Hospital Division a considerable portion of that would be obligations for the Hospital Division. EXPENDITURES FOR BURIALS Mr. LUDLOW. There is an increase of $2,770 in the item for burials. That is a mathematical proposition? Dr. ANDERSON. That is right. It is on the basis of our previous experience. Mr. LUDLOW. On page 36 of the justifications there is a statement to the effect that there is a rising trend in out-patient care. That has reference to merchant seamen? Dr. ANDERSON. Yes, sir; there is an increase in the number of merchant seamen being hospitalized, and also there are indications that our Coast Guard load is going down. DECREASE IN NUMBER OF PATIENTS Mr. LUDLOW. Why should not the trend, generally speaking, be downward? Dr. ANDERSON. The trend over-all is downward to the extent of about 3 percent in the daily average load. Mr. TABER. You have how many patients presently? Dr. ANDERSON. How many patients in what connection? Dr. ANDERSON. Approximately 6,800 in patients. Mr. TABER. How many of those are Veterans' Administration patients? Dr. ANDERSON. One thousand and four. Mr. TABER. How many of them are Army or Navy patients, or both? Do you have the figures separately? Dr. ANDERSON. I cannot give you that figure, but it is very small. I can furnish that figure for the record. Mr. TABER. Is the number of Veterans' Administration patients increasing? Dr. ANDERSON. Yes, sir. Mr. TABER. Substantially? Dr. ANDERSON. To the extent that our facilities will accommodate them, but it cannot go much beyond our present daily average load. OBLIGATIONS AND EXPENDITURES Mr. TABER. What have been your obligations over-all for the first 6 months? Dr. ANDERSON. The total obligations are $10,449,923. Mr. TABER. That includes disbursements out of reimbursements, does it not? Dr. ANDERSON. Yes, sir. Mr. TABER. On that basis you are asking for a build-up of about $2,500,000 for the last half of the year, are you not? Dr. ANDERSON. That is correct, sir. Mr. TABER. Why is that? Dr. ANDERSON. The reasons are essentially these: First, they are higher because we must have additional personnel in connection with conversion to the shorter workweek and replacement of free personal services. There is a backlog of obligations concerned with contract services, supplies, and equipment. As to contract services, I wish to mention again that there is no appreciable increase in the number of patients, but there was an inadequate amount of funds in the original 1946 appropriation. Mr. TABER. Your patient load is not larger than it was estimated to be, is it? Dr. ANDERSON. Our patient load-is not larger at this time? Dr. ANDERSON. Yes, sir; it is somewhat larger. Mr. TABER. Very little. Dr. ANDERSON. Very little; yes, sir. In connection with that, the 1946 original appropriation provides for estimates based on 6,005 daily average patient load in marine hospitals whereas our experience is running at 6,593, which should be stated as an appreciable increase rather than a slight increase. I would like to make a further remark in connection with the additional personnel required for the conversion to the shorter workweek. We, of course, will not be able to place them on duty until funds become available on July 1, and we are facing the requirement that we reduce to the shorter work week by July 1, 1946. |